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Lorenzana I, Galera R, Casitas R, Martínez-Cerón E, Castillo MA, Alfaro E, Cubillos-Zapata C, García-Río F. Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients. Respir Med 2024; 225:107597. [PMID: 38499274 DOI: 10.1016/j.rmed.2024.107597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. METHODS A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. RESULTS 58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5-14.8 vs. 7.2; 95% CI, 7.1-7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010-8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385-11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087-2.581). CONCLUSION In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.
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Affiliation(s)
- Isabel Lorenzana
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Raúl Galera
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Raquel Casitas
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain; Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Enrique Alfaro
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Francisco García-Río
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain; Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
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2
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Quiroga TN, Bachar N, Voigt W, Danino N, Shafran I, Shtrichman R, Shuster G, Lambrecht N, Eisenmann S. Changes in tidal breathing biomarkers as indicators of treatment response in AECOPD patients in an acute care setting. Adv Med Sci 2023; 68:176-185. [PMID: 37146372 DOI: 10.1016/j.advms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a complication of COPD that typically necessitates intensified treatment and hospitalization. It is linked to higher morbidity, mortality and healthcare spending. Assessment of therapy response for AECOPD is difficult due to the variability of symptoms and limitations in current measures. Hence, there is a need for new biomarkers to aid in the management of AECOPD in acute care settings. MATERIALS AND METHODS Fifteen hospitalized AECOPD patients (GOLD 3-4) were enrolled in this study. Treatment response was assessed daily through clinical evaluations and by monitoring tidal breathing biomarkers (respiratory rate [RR], expiratory time [Tex], inspiratory time [Tin], expiratory pause [Trst], total breath time [Ttot]), using a novel, wearable nanosensor-based device (SenseGuard™). RESULTS Patients who showed significant clinical improvement had substantial changes in ΔTex/Ttot (+14%), ΔTrst/Ttot (-18%), and ΔTin/Tex (+0.09), whereas patients who showed mild or no clinical improvement had smaller changes (+5%, +3%, and -0.03, respectively). Linear regression between change in physician's assessment score and the median change in tidal breathing parameters was significant for Tin/Tex (R2 = 0.449, ∗p = 0.017), Tex/Ttot (R2 = 0.556, ∗p = 0.005) and Trst/Ttot (R2 = 0.446, ∗p = 0.018), while no significant regression was observed for RR, Tin/(Trst + Tex) and Tin/Ttot. CONCLUSIONS Our study demonstrates the potential of the SenseGuard™ to monitor treatment response in AECOPD patients by measuring changes in tidal breathing biomarkers, which were shown to be associated with significant changes in the patients' respiratory condition as evaluated by physicians. However, further large-scale clinical studies are needed to confirm these findings.
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Affiliation(s)
- Tess Nuñez Quiroga
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | | | - Wieland Voigt
- NanoVation-GS LTD, Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
| | | | | | | | | | - Nina Lambrecht
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
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Do W, Russell R, Wheeler C, Lockwood M, De Vos M, Pavord I, Bafadhel M. Performance of Contactless Respiratory Rate Monitoring by Albus Home TM, an Automated System for Nocturnal Monitoring at Home: A Validation Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197142. [PMID: 36236241 PMCID: PMC9573065 DOI: 10.3390/s22197142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 06/12/2023]
Abstract
Respiratory rate (RR) is a clinically important predictor of cardio-respiratory deteriorations. The mainstay of clinical measurement comprises the manual counting of chest movements, which is variable between clinicians and limited to sporadic readings. Emerging solutions are limited by poor adherence and acceptability or are not clinically validated. Albus HomeTM is a contactless and automated bedside system for nocturnal respiratory monitoring that overcomes these limitations. This study aimed to validate the accuracy of Albus Home compared to gold standards in real-world sleeping environments. Participants undertook overnight monitoring simultaneously using Albus Home and gold-standard polygraphy with thoraco-abdominal respiratory effort belts (SomnomedicsEU). Reference RR readings were obtained by clinician-count of polygraphy data. For both the Albus system and reference, RRs were measured in 30-s segments, reported as breaths/minute, and compared. Accuracy was defined as the percentage of RRs from the Albus system within ±2 breaths/minute of reference counts. Across a diverse validation set of 32 participants, the mean accuracy exceeded 98% and was maintained across different participant characteristics. In a Bland-Altman analysis, Albus RRs had strong agreement with reference mean differences and the limits of agreement of -0.4 and ±1.2 breaths/minute, respectively. Albus Home is a contactless yet accurate system for automated respiratory monitoring. Validated against gold -standard methods, it enables long-term, reliable nocturnal monitoring without patient burden.
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Affiliation(s)
| | - Richard Russell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | | | | | - Maarten De Vos
- Department of Electrical Engineering and Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Mona Bafadhel
- King’s Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
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4
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Toften S, Kjellstadli JT, Thu OKF, Ellingsen OJ. Noncontact Longitudinal Respiratory Rate Measurements in Healthy Adults Using Radar-Based Sleep Monitor (Somnofy): Validation Study. JMIR BIOMEDICAL ENGINEERING 2022; 7:e36618. [PMID: 38875674 PMCID: PMC11041471 DOI: 10.2196/36618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Respiratory rate (RR) is arguably the most important vital sign to detect clinical deterioration. Change in RR can also, for example, be associated with the onset of different diseases, opioid overdoses, intense workouts, or mood. However, unlike for most other vital parameters, an easy and accurate measuring method is lacking. OBJECTIVE This study aims to validate the radar-based sleep monitor, Somnofy, for measuring RRs and investigate whether events affecting RR can be detected from personalized baselines calculated from nightly averages. METHODS First, RRs from Somnofy for 37 healthy adults during full nights of sleep were extensively validated against respiratory inductance plethysmography. Then, the night-to-night consistency of a proposed filtered average RR was analyzed for 6 healthy participants in a pilot study in which they used Somnofy at home for 3 months. RESULTS Somnofy measured RR 84% of the time, with mean absolute error of 0.18 (SD 0.05) respirations per minute, and Bland-Altman 95% limits of agreement adjusted for repeated measurements ranged from -0.99 to 0.85. The accuracy and coverage were substantially higher in deep and light sleep than in rapid eye movement sleep and wake. The results were independent of age, sex, and BMI, but dependent on supine sleeping position for some radar orientations. For nightly filtered averages, the 95% limits of agreement ranged from -0.07 to -0.04 respirations per minute. In the longitudinal part of the study, the nightly average was consistent from night to night, and all substantial deviations coincided with self-reported illnesses. CONCLUSIONS RRs from Somnofy were more accurate than those from any other alternative method suitable for longitudinal measurements. Moreover, the nightly averages were consistent from night to night. Thus, several factors affecting RR should be detectable as anomalies from personalized baselines, enabling a range of applications. More studies are necessary to investigate its potential in children and older adults or in a clinical setting.
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Affiliation(s)
- Ståle Toften
- Department of Data Science and Research, VitalThings AS, Tønsberg, Norway
| | | | - Ole Kristian Forstrønen Thu
- VitalThings AS, Tønsberg, Norway
- Department of Anesthesiology and Intensive Care Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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5
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Hawthorne G, Richardson M, Greening NJ, Esliger D, Briggs-Price S, Chaplin EJ, Clinch L, Steiner MC, Singh SJ, Orme MW. A proof of concept for continuous, non-invasive, free-living vital signs monitoring to predict readmission following an acute exacerbation of COPD: a prospective cohort study. Respir Res 2022; 23:102. [PMID: 35473718 PMCID: PMC9044843 DOI: 10.1186/s12931-022-02018-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of vital signs monitoring in the early recognition of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) post-hospital discharge is limited. This study investigated whether continuous vital signs monitoring could predict an AECOPD and readmission. Methods 35 people were recruited at discharge following hospitalisation for an AECOPD. Participants were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks and to complete the Exacerbations of Chronic Pulmonary Disease Tool (EXACT), a 14-item symptom diary, daily. The Equivital LifeMonitor recorded respiratory rate (RR), heart rate (HR), skin temperature (ST) and physical activity (PA) every 15-s. An AECOPD was classified as mild (by EXACT score), moderate (prescribed oral steroids/antibiotics) or severe (hospitalisation). Results Over the 6-week period, 31 participants provided vital signs and symptom data and 14 participants experienced an exacerbation, of which, 11 had sufficient data to predict an AECOPD. HR and PA were associated with EXACT score (p < 0.001). Three days prior to an exacerbation, RR increased by mean ± SD 2.0 ± 0.2 breaths/min for seven out of 11 exacerbations and HR increased by 8.1 ± 0.7 bpm for nine of these 11 exacerbations. Conclusions Increased heart rate and reduced physical activity were associated with worsening symptoms. Even with high-resolution data, the variation in vital signs data remains a challenge for predicting AECOPDs. Respiratory rate and heart rate should be further explored as potential predictors of an impending AECOPD. Trial registration: ISRCTN registry; ISRCTN12855961. Registered 07 November 2018—Retrospectively registered, https://www.isrctn.com/ISRCTN12855961 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02018-5.
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Affiliation(s)
- Grace Hawthorne
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
| | - Matthew Richardson
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Dale Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Samuel Briggs-Price
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Emma J Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Lisa Clinch
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Michael C Steiner
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Mark W Orme
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
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6
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Straßburg S, Linker CM, Brato S, Schöbel C, Taube C, Götze J, Stehling F, Sutharsan S, Welsner M, Weinreich G. Investigation of respiratory rate in patients with cystic fibrosis using a minimal-impact biomotion system. BMC Pulm Med 2022; 22:59. [PMID: 35148739 PMCID: PMC8832687 DOI: 10.1186/s12890-022-01855-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background In this study we tested the hypothesis that in patients with cystic fibrosis (pwCF) respiratory rate (RR) is associated with antibiotic treatment, exacerbation status, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP). Methods Between June 2018 and May 2019, we consecutively enrolled pwCF who were referred to our hospital. We determined RR and heart rate (HR) by using the minimal-impact system VitaLog during the hospital stay. Furthermore, we performed spirometry and evaluated CRP. Results We included 47 patients: 20 with pulmonary exacerbation and 27 without. RR decreased in patients with exacerbation (27.5/min (6.0/min) vs. 24.4/min (6.0/min), p = 0.004) and in patients with non-exacerbation (22.5/min (5.0/min) vs. 20.9/min (3.5/min), p = 0.024). Patients with exacerbation showed higher RR than patients with non-exacerbation both at the beginning (p = 0.004) and at the end of their hospital stay (p = 0.023). During the hospital stay, HR did not change in the total cohort (66.8/min (11.0/min) vs. 66.6/min (12.0/min), p = 0.440). Furthermore, we did not find significant differences between patients with exacerbation and patients with non-exacerbation (67.0/min (12.5/min) vs. 66.5/min (10.8/min), p = 0.658). We observed a correlation of ρ = -0.36 between RR and FEV1. Moreover, we found a correlation of ρ = 0.52 between RR and CRP. Conclusion In pwCF requiring intravenous therapy, respiratory rate is higher at their hospital admittance and decreased by the time of discharge; it is also associated with C-reactive protein. Monitoring RR could provide important information about the overall clinical conditions of pwCF.
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Affiliation(s)
- Svenja Straßburg
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany.
| | - Carolin-Maria Linker
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany.,Information Processing Lab, Faculty of Electrical Engineering, Information Engineering - TU Dortmund, Dortmund, Germany
| | | | - Christoph Schöbel
- Center of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
| | - Jürgen Götze
- Information Processing Lab, Faculty of Electrical Engineering, Information Engineering - TU Dortmund, Dortmund, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children'S Hospital, University Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
| | - Matthias Welsner
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
| | - Gerhard Weinreich
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
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7
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Lauteslager T, Maslik M, Siddiqui F, Marfani S, Leschziner GD, Williams AJ. Validation of a New Contactless and Continuous Respiratory Rate Monitoring Device Based on Ultra-Wideband Radar Technology. SENSORS 2021; 21:s21124027. [PMID: 34207961 PMCID: PMC8230718 DOI: 10.3390/s21124027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Respiratory rate (RR) is typically the first vital sign to change when a patient decompensates. Despite this, RR is often monitored infrequently and inaccurately. The Circadia Contactless Breathing Monitor™ (model C100) is a novel device that uses ultra-wideband radar to monitor RR continuously and un-obtrusively. Performance of the Circadia Monitor was assessed by direct comparison to manually scored reference data. Data were collected across a range of clinical and non-clinical settings, considering a broad range of user characteristics and use cases, in a total of 50 subjects. Bland-Altman analysis showed high agreement with the gold standard reference for all study data, and agreement fell within the predefined acceptance criteria of ±5 breaths per minute (BrPM). The 95% limits of agreement were -3.0 to 1.3 BrPM for a nonprobability sample of subjects while awake, -2.3 to 1.7 BrPM for a clinical sample of subjects while asleep, and -1.2 to 0.7 BrPM for a sample of healthy subjects while asleep. Accuracy rate, using an error margin of ±2 BrPM, was found to be 90% or higher. Results demonstrate that the Circadia Monitor can effectively and efficiently be used for accurate spot measurements and continuous bedside monitoring of RR in low acuity settings, such as the nursing home or hospital ward, or for remote patient monitoring.
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8
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Mkorombindo T, Dransfield MT. COPD: COagulation-associated Pulmonary Disease? Respirology 2021; 26:290-291. [PMID: 33432655 DOI: 10.1111/resp.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA
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9
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Nicolò A, Massaroni C, Schena E, Sacchetti M. The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6396. [PMID: 33182463 PMCID: PMC7665156 DOI: 10.3390/s20216396] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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10
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Rubio N, Parker RA, Drost EM, Pinnock H, Weir CJ, Hanley J, Mantoani LC, MacNee W, McKinstry B, Rabinovich RA. Home monitoring of breathing rate in people with chronic obstructive pulmonary disease: observational study of feasibility, acceptability, and change after exacerbation. Int J Chron Obstruct Pulmon Dis 2017; 12:1221-1231. [PMID: 28458534 PMCID: PMC5404493 DOI: 10.2147/copd.s120706] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Telehealth programs to promote early identification and timely self-management of acute exacerbations of chronic obstructive pulmonary diseases (AECOPDs) have yielded disappointing results, in part, because parameters monitored (symptoms, pulse oximetry, and spirometry) are weak predictors of exacerbations.
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Affiliation(s)
- Noah Rubio
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Ellen M Drost
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place.,EHealth group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Lothian, UK
| | - Leandro C Mantoani
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - William MacNee
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Brian McKinstry
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh.,EHealth group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Roberto A Rabinovich
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
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11
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Avriel A, Rozenberg D, Raviv Y, Heimer D, Bar-Shai A, Gavish R, Sheynin J, Douvdevani A. Prognostic utility of admission cell-free DNA levels in patients with chronic obstructive pulmonary disease exacerbations. Int J Chron Obstruct Pulmon Dis 2016; 11:3153-3161. [PMID: 28003743 PMCID: PMC5158140 DOI: 10.2147/copd.s113256] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Chronic obstructive pulmonary disease exacerbations (COPDEs) are associated with increased morbidity and mortality. Cell-free DNA (cfDNA) is a novel biomarker associated with clinical outcomes in several disease states but has not been studied in COPD. The objectives of this study were to assess cfDNA levels during a COPDE, to evaluate the association of cfDNA with clinical parameters and to explore the prognostic implications of cfDNA levels on long-term survival. Methods This was an observational study that assessed cfDNA levels in patients admitted to hospital for a COPDE. Plasma cfDNA levels of COPDE patients were compared to those of matched stable COPD patients and healthy controls. Multivariable and Cox regression analyses were used to assess the association of cfDNA levels with blood gas parameters and long-term survival. Results A total of 62 patients (46 males, forced expiratory volume in 1 second [FEV1] 38%±13%) were included. The median cfDNA levels on admission for COPDE patients was 1,634 ng/mL (interquartile range [IQR] 1,016–2,319) compared to 781 ng/mL (IQR 523–855) for stable COPD patients, matched for age and disease severity, and 352 ng/mL (IQR 209–636) for healthy controls (P<0.0001, for both comparisons). cfDNA was correlated with partial arterial pressure of carbon dioxide (PaCO2, r=0.35) and pH (r=−0.35), P=0.01 for both comparisons. In a multivariable analysis, PaCO2 was the only independent predictor of cfDNA. Using a cfDNA level of 1,924 ng/mL (threshold for abnormal PaCO2), those with high levels had a trend for increased 5-year mortality risk adjusted for age, sex and FEV1% (hazard ratio 1.92, 95% confidence interval 0.93–3.95, P=0.08). Conclusion Plasma cfDNA might offer a novel technique to identify COPD patients at increased risk of poor outcomes, but the prognostic utility of this measurement requires further study.
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Affiliation(s)
- Avital Avriel
- Department of Medicine, Pulmonology Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yael Raviv
- Department of Medicine, Pulmonology Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Dov Heimer
- Department of Medicine, Pulmonology Institute, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Amir Bar-Shai
- Department of Medicine, Pulmonology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv
| | - Rachel Gavish
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Jony Sheynin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Clinical Biochemistry, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Amos Douvdevani
- Department of Clinical Biochemistry, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel
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Lee SJ, Lee HR, Lee TW, Ju S, Lim S, Go SI, You JW, Cho YJ, Lee GW, Jeong YY, Kim HC, Lee JD. Usefulness of neutrophil to lymphocyte ratio in patients with chronic obstructive pulmonary disease: a prospective observational study. Korean J Intern Med 2016; 31:891-8. [PMID: 27017385 PMCID: PMC5016279 DOI: 10.3904/kjim.2015.084] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS Neutrophil to lymphocyte ratio (NLR) in peripheral blood is a useful systemic inflammatory response biomarker. However, NLR has not been studied in patients with chronic obstructive pulmonary disease (COPD). This study was aimed to evaluate the usefulness of NLR in patients with COPD. METHODS NLR was prospectively measured and compared in patients with COPD exacerbation (n = 59), patients with stable COPD (n = 61), and healthy controls (n = 28). NLR in patients with COPD exacerbation was repeatedly measured in the convalescent period. The correlation between NLR and clinical parameters was evaluated, and the predictors for respiratory hospitalization were analyzed by multivariate logistic regression. RESULTS NLR values were significantly higher in patients with COPD exacerbation compared with stable COPD patients and controls (12.4 ± 10.6, 2.4 ± 0.7, 1.4 ± 0.5, respectively; p < 0.001). NLR was significantly decreased during the convalescent period in patients with COPD exacerbation (4.5 ± 4.6 vs. 11.5 ± 8.8, p < 0.001). NLR exhibited a significant correlation with the body mass index, degree of airway obstruction, dyspnea, and exercise capacity (BODE) index, the 6-minute walk test, and the modified Medical Research Council scale. NLR ≥ 2.8 was an independent predictor with a borderline significance for respiratory hospitalization (odds ratio, 2.083; p = 0.079). Body mass index and forced expiratory volume in 1 second were independent predictors for respiratory hospitalization. CONCLUSIONS NLR is a straightforward and effective biomarker of COPD exacerbation that may serve as a predictor for respiratory hospitalization in patients with COPD.
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Affiliation(s)
- Seung Jun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyang Rae Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae Won Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sunmi Ju
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sujin Lim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Se-Il Go
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung-Wan You
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Deog Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
- Correspondence to Jong Deog Lee, M.D. Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Korea Tel: +82-55-750-8611 Fax: +82-55-758-9122 E-mail:
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Montserrat-Capdevila J, Godoy P, Marsal JR, Barbé F, Galván L. Risk of exacerbation in chronic obstructive pulmonary disease: a primary care retrospective cohort study. BMC FAMILY PRACTICE 2015; 16:173. [PMID: 26642879 PMCID: PMC4672528 DOI: 10.1186/s12875-015-0387-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/25/2015] [Indexed: 12/28/2022]
Abstract
Background The risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors. Predictive models of exacerbation are more accurate than the forced expiratory volume in one second (FEV1). The objective was to design a model that predicts the risk of exacerbation in COPD. Methods Retrospective cohort study with data from the electronic medical records of patients diagnosed with COPD in the province of Lleida (Spain). A total of 2501 patients were followed during 3 years. The dependent variable was acute exacerbation; independent variables were: clinical parameters, spirometry results, severity of disease, influenza and 23-valent pneumococcal immunisation, comorbidities, smoking and history of exacerbation. The association of these variables with disease exacerbation was measured by the adjusted odds ratio using a logistic regression model. Results Mean age at the start of the study was 68.38 years (SD = 11.60) and 74.97 % patients were men; severity of disease was considered mild in 50.82 % of patients, moderate in 35.31 %, severe in 9.44 % and very severe in 4.44 %. During the three year study period up to 83.17 % of patients experienced at least one exacerbation. Predictive factors in the model were age, gender, previous exacerbations, influenza and 23-valent pneumococcal immunisations, number of previous visits to the General Practice and severity (GOLD), with an area under the ROC curve (AUROC) of 0.70. Conclusions This model can identify patients at high risk of acute exacerbation. Preventive measures and modification of treatment in these high-risk patients would improve survival.
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Affiliation(s)
- Josep Montserrat-Capdevila
- Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain. .,Health Department, Public Health Agency of Catalonia, Lleida, Catalonia, Spain. .,Catalan Institute of Health (ICS), Mollerussa/Lleida, Catalonia, Spain.
| | - Pere Godoy
- Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain.,Health Department, Public Health Agency of Catalonia, Lleida, Catalonia, Spain.,Faculty of Medicine, University of Lleida, Lleida, Catalonia, Spain
| | - Josep Ramon Marsal
- Lleida Research Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol. Autonomous University of Barcelona, Lleida, Catalonia, Spain.,Cardiovascular Department, Epidemiology Unit, University Hospital Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Ferran Barbé
- Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain.,Catalan Institute of Health (ICS), Mollerussa/Lleida, Catalonia, Spain.,Faculty of Medicine, University of Lleida, Lleida, Catalonia, Spain.,Pneumology Unit, University Hospital Arnau de Vilanova, Lleida, Catalonia, Spain.,Biomedical Research Centre Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | - Leonardo Galván
- Pharmacy Unit. Catalan Health Service, Lleida, Catalonia, Spain
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15
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Teutonico D, Musuamba F, Maas HJ, Facius A, Yang S, Danhof M, Della Pasqua O. Generating Virtual Patients by Multivariate and Discrete Re-Sampling Techniques. Pharm Res 2015; 32:3228-37. [PMID: 25994981 PMCID: PMC4577546 DOI: 10.1007/s11095-015-1699-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/15/2015] [Indexed: 11/26/2022]
Abstract
Purpose Clinical Trial Simulations (CTS) are a valuable tool for decision-making during drug development. However, to obtain realistic simulation scenarios, the patients included in the CTS must be representative of the target population. This is particularly important when covariate effects exist that may affect the outcome of a trial. The objective of our investigation was to evaluate and compare CTS results using re-sampling from a population pool and multivariate distributions to simulate patient covariates. Methods COPD was selected as paradigm disease for the purposes of our analysis, FEV1 was used as response measure and the effects of a hypothetical intervention were evaluated in different populations in order to assess the predictive performance of the two methods. Results Our results show that the multivariate distribution method produces realistic covariate correlations, comparable to the real population. Moreover, it allows simulation of patient characteristics beyond the limits of inclusion and exclusion criteria in historical protocols. Conclusion Both methods, discrete resampling and multivariate distribution generate realistic pools of virtual patients. However the use of a multivariate distribution enable more flexible simulation scenarios since it is not necessarily bound to the existing covariate combinations in the available clinical data sets. Electronic supplementary material The online version of this article (doi:10.1007/s11095-015-1699-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Teutonico
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - F Musuamba
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - H J Maas
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Stockley Park, Middlesex, UK
| | - A Facius
- Department of Pharmacometrics, Nycomed GmbH, Constance, Germany
| | - S Yang
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Stockley Park, Middlesex, UK
| | - M Danhof
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - O Della Pasqua
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands.
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline, Stockley Park, Middlesex, UK.
- Clinical Pharmacology & Therapeutics, University College London, BMA House, Tavistock Square, London, WC1H 9JP, UK.
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Cazzola M, Hanania NA, MacNee W, Rüdell K, Hackford C, Tamimi N. A review of the most common patient-reported outcomes in COPD--revisiting current knowledge and estimating future challenges. Int J Chron Obstruct Pulmon Dis 2015; 10:725-38. [PMID: 25897216 PMCID: PMC4396518 DOI: 10.2147/copd.s77368] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patient-reported outcome (PRO) measures that quantify disease impact have become important measures of outcome in COPD research and treatment. The objective of this literature review was to comprehensively evaluate psychometric properties of available PRO instruments and the ability of each of them to characterize pharmaceutical treatment effects from published clinical trial evidence. Identified in this study were several PRO measures, both those that have been used extensively in COPD clinical trials (St George’s Respiratory Questionnaire and Chronic Respiratory Questionnaire) and new instruments whose full value is still to be determined. This suggests a great need for more information about the patient experience of treatment benefit, but this also may pose challenges to researchers, clinicians, and other important stakeholders (eg, regulatory agencies, pharmaceutical companies) who develop new treatment entities and payers (including but not limited to health technology assessment agencies such as the National Institute for Health and Care Excellence and the Canadian Agency for Drugs and Technologies in Health). The purpose of this review is to enable researchers and clinicians to gain a broad overview of PRO measures in COPD by summarizing the value and purpose of these measures and by providing sufficient detail for interested audiences to determine which instrument may be the most suitable for evaluating a particular research purpose.
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Affiliation(s)
- Mario Cazzola
- University of Rome 'Tor Vergata', Department of Medicine of Systems, Unit of Respiratory Clinical Pharmacology, Rome, Italy
| | - Nicola Alexander Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - William MacNee
- University of Edinburgh/MRC Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Katja Rüdell
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
| | - Claire Hackford
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
| | - Nihad Tamimi
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
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Montserrat-Capdevila J, Godoy P, Marsal JR, Barbé-Illa F. [Risk factors for mortality in patients with chronic obstructive pulmonary disease]. Aten Primaria 2015; 47:498-504. [PMID: 25778409 PMCID: PMC6983683 DOI: 10.1016/j.aprim.2014.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/12/2014] [Accepted: 11/10/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify risk factors of mortality in patients with chronic obstructive pulmonary disease (COPD). DESIGN A retrospective cohort study. LOCATION Primary care setting in Lleida, Spain. PARTICIPANTS 2.501 patients older than 40 years with at least a spirometry in the 24 months prior to the beginning of the study were followed for 3 years. MAIN MEASUREMENTS The dependent variable was the overall mortality in the period 11/01/2010-10/31/2013; and the independents: spirometric parameters, severity (GOLD) and clinical variables. Their association with mortality was analyzed by calculating the adjusted odds ratio using a non-conditional logistic regression model. RESULTS The average age of 2.501 patients at the beginning of the study was 68.4 years (SD=11.6). 75.0% were males. 50.8% had a mild severity COPD, followed by moderate (35.3%), severe (9.4%) and very severe (4.4%). Mortality rate for the all period was 12.55%. The variables of the predictive model were: age, male sex, previous exacerbations, number of visits to primary care, comorbidity, smoking, severity of COPD (GOLD) and not receiving influenza vaccination, with an area under the ROC curve of 0.76. CONCLUSIONS This model, easy and quick to apply, would identify those patients at increased risk of mortality and who could benefit from preventive strategies to improve their survival.
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Affiliation(s)
- Josep Montserrat-Capdevila
- Institut de Recerca Biomèdica (IRB) Lleida, Lleida, España; Departament de Salut, Agència de Salut Pública de Catalunya, Lleida, España; CAP Mollerussa, Institut Català de la Salut (ICS), Mollerussa, España.
| | - Pere Godoy
- Institut de Recerca Biomèdica (IRB) Lleida, Lleida, España; Departament de Salut, Agència de Salut Pública de Catalunya, Lleida, España; Facultat de Medicina, Universitat de Lleida, Lleida, España
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida, Lleida, España; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, España; Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Ferran Barbé-Illa
- Institut de Recerca Biomèdica (IRB) Lleida, Lleida, España; Hospital Universitari Arnau de Vilanova, Lleida, España; Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
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18
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Mohktar MS, Redmond SJ, Antoniades NC, Rochford PD, Pretto JJ, Basilakis J, Lovell NH, McDonald CF. Predicting the risk of exacerbation in patients with chronic obstructive pulmonary disease using home telehealth measurement data. Artif Intell Med 2014; 63:51-9. [PMID: 25704112 DOI: 10.1016/j.artmed.2014.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of telehealth technologies to remotely monitor patients suffering chronic diseases may enable preemptive treatment of worsening health conditions before a significant deterioration in the subject's health status occurs, requiring hospital admission. OBJECTIVE The objective of this study was to develop and validate a classification algorithm for the early identification of patients, with a background of chronic obstructive pulmonary disease (COPD), who appear to be at high risk of an imminent exacerbation event. The algorithm attempts to predict the patient's condition one day in advance, based on a comparison of their current physiological measurements against the distribution of their measurements over the previous month. METHOD The proposed algorithm, which uses a classification and regression tree (CART), has been validated using telehealth measurement data recorded from patients with moderate/severe COPD living at home. The data were collected from February 2007 to January 2008, using a telehealth home monitoring unit. RESULTS The CART algorithm can classify home telehealth measurement data into either a 'low risk' or 'high risk' category with 71.8% accuracy, 80.4% specificity and 61.1% sensitivity. The algorithm was able to detect a 'high risk' condition one day prior to patients actually being observed as having a worsening in their COPD condition, as defined by symptom and medication records. CONCLUSION The CART analyses have shown that features extracted from three types of physiological measurements; forced expiratory volume in 1s (FEV1), arterial oxygen saturation (SPO2) and weight have the most predictive power in stratifying the patients condition. This CART algorithm for early detection could trigger the initiation of timely treatment, thereby potentially reducing exacerbation severity and recovery time and improving the patient's health. This study highlights the potential usefulness of automated analysis of home telehealth data in the early detection of exacerbation events among COPD patients.
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Affiliation(s)
- Mas S Mohktar
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Stephen J Redmond
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nick C Antoniades
- Institute for Breathing and Sleep, Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria 3081, Australia.
| | - Peter D Rochford
- Institute for Breathing and Sleep, Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria 3081, Australia.
| | - Jeffrey J Pretto
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle 2305, Australia.
| | - Jim Basilakis
- School of Computing and Mathematics, University of Western Sydney, Sydney, NSW 2751, Australia.
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Christine F McDonald
- Institute for Breathing and Sleep, Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria 3081, Australia.
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Ballal T, Heneghan C, Zaffaroni A, Boyle P, de Chazal P, Shouldice R, McNicholas WT, Donnelly SC. A pilot study of the nocturnal respiration rates in COPD patients in the home environment using a non-contact biomotion sensor. Physiol Meas 2014; 35:2513-27. [PMID: 25402668 DOI: 10.1088/0967-3334/35/12/2513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nocturnal respiration rate parameters were collected from 20 COPD subjects over an 8 week period, to determine if changes in respiration rate were associated with exacerbations of COPD. These subjects were primarily GOLD Class 2 to 4, and had been recently discharged from hospital following a recent exacerbation. The respiration rates were collected using a non-contact radio-frequency biomotion sensor which senses respiratory effort and body movement using a short-range radio-frequency sensor. An adaptive notch filter was applied to the measured signal to determine respiratory rate over rolling 15 s segments. The accuracy of the algorithm was initially verified using ten manually-scored 15 min segments of respiration extracted from overnight polysomnograms. The calculated respiration rates were within 1 breath min(-1) for >98% of the estimates. For the 20 subjects monitored, 11 experienced one or more subsequent exacerbation of COPD (ECOPD) events during the 8 week monitoring period (19 events total). Analysis of the data revealed a significant increase in nocturnal respiration rate (e.g. >2 breath min(-1)) prior to many ECOPD events. Using a simple classifier of a change of 1 breath min(-1) in the mode of the nocturnal respiration rate, a predictive rule showed a sensitivity of 63% and specificity of 85% for predicting an exacerbation within a 5 d window. We conclude that it is possible to collect respiration rates reliably in the home environment, and that the respiration rate may be a potential indicator of change in clinical status.
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Affiliation(s)
- Tarig Ballal
- King Abdullah University of Science and Technology, Saudi Arabia
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20
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Musuamba FT, Teutonico D, Maas HJ, Facius A, Yang S, Danhof M, Della Pasqua O. Prediction of disease progression, treatment response and dropout in chronic obstructive pulmonary disease (COPD). Pharm Res 2014; 32:617-27. [PMID: 25231008 PMCID: PMC4300418 DOI: 10.1007/s11095-014-1490-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/15/2014] [Indexed: 11/24/2022]
Abstract
Purpose Drug development in chronic obstructive pulmonary disease (COPD) has been characterised by unacceptably high failure rates. In addition to the poor sensitivity in forced expiratory volume in one second (FEV1), numerous causes are known to contribute to this phenomenon, which can be clustered into drug-, disease- and design-related factors. Here we present a model-based approach to describe disease progression, treatment response and dropout in clinical trials with COPD patients. Methods Data from six phase II trials lasting up to 6 months were used. Disease progression (trough FEV1 measurements) was modelled by a time–varying function, whilst the treatment effect was described by an indirect response model. A time-to-event model was used for dropout Results All relevant parameters were characterised with acceptable precision. Two parameters were necessary to model the dropout patterns, which was found to be partly linked to the treatment failure. Disease severity at baseline, previous use of corticosteroids, gender and height were significant covariates on disease baseline whereas disease severity and reversibility to salbutamol/salmeterol were significant covariates on Emax for salmeterol active arm. Conclusion Incorporation of the various interacting factors into a single model will offer the basis for patient enrichment and improved dose rationale in COPD. Electronic supplementary material The online version of this article (doi:10.1007/s11095-014-1490-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F T Musuamba
- Gorlaeus Laboratories, Division of Pharmacology, Leiden Academic Centre for Drug Research, P.O. Box 9502, 2300 RA, Leiden, The Netherlands
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Usher AKH, Stockley RA. The link between chronic periodontitis and COPD: a common role for the neutrophil? BMC Med 2013; 11:241. [PMID: 24229090 PMCID: PMC4225606 DOI: 10.1186/1741-7015-11-241] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 11/01/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The possible relationship between chronic inflammatory diseases and their co-morbidities has become an increasing focus of research. Both chronic periodontitis and chronic obstructive pulmonary disease are neutrophilic, inflammatory conditions characterized by the loss of local connective tissue. Evidence suggests an association and perhaps a causal link between the two diseases. However, the nature of any relationship between them is unclear, but if pathophysiologically established may have wide-reaching implications for targeted treatments to improve outcomes and prognosis. DISCUSSION There have been a number of epidemiological studies undertaken demonstrating an independent association between chronic periodontitis and chronic obstructive pulmonary disease. However, many of them have significant limitations, and drawing firm conclusions regarding causality may be premature. Although the pathology of both these diseases is complex and involves many cell types, such as CD8 positive cells and macrophages, both conditions are predominantly characterized by neutrophilic inflammation. Increasingly, there is evidence that the two conditions are underpinned by similar pathophysiological processes, especially centered on the functions of the neutrophil. These include a disturbance in protease/anti-protease and redox state balance. The association demonstrated by epidemiological studies, as well as emerging similarities in pathogenesis at the level of the neutrophil, suggest a basis for testing the effects of treatment for one condition upon the severity of the other. SUMMARY Although the evidence of an independent association between chronic periodontitis and chronic obstructive pulmonary disease grows stronger, there remains a lack of definitive studies designed to establish causality and treatment effects. There is a need for future research to be focused on answering these questions.
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Affiliation(s)
- Adam K H Usher
- Lung Investigation Unit, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
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Ryan M, Suaya JA, Chapman JD, Stason WB, Shepard DS, Parks Thomas C. Incidence and cost of pneumonia in older adults with COPD in the United States. PLoS One 2013; 8:e75887. [PMID: 24130749 PMCID: PMC3794002 DOI: 10.1371/journal.pone.0075887] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To estimate the incidence of pneumonia by COPD status and the excess cost of inpatient primary pneumonia in elders with COPD. Study Design A retrospective, longitudinal study using claims linked to eligibility/demographic data for a 5% sample of fee-for-service Medicare beneficiaries from 2005 through 2007. Methods Incidence rates of pneumonia were calculated for elders with and without COPD and for elders with COPD and coexistent congestive heart failure (CHF). Propensity-score matching with multivariate generalized linear regression was used to estimate the excess direct medical cost of inpatient primary pneumonia in elders with COPD as compared with elders with COPD but without a pneumonia hospitalization. Results Elders with COPD had nearly six-times the incidence of pneumonia compared with elders without COPD (167.6/1000 person-years versus 29.5/1000 person-years; RR=5.7, p <0 .01); RR increased to 8.1 for elders with COPD and CHF compared with elders without COPD. The incidence of inpatient primary pneumonia among elders with COPD was 54.2/1000 person-years compared with 7/1000 person-years for elders without COPD; RR=7.7, p<0.01); RR increased to 11.0 for elders with COPD and CHF compared with elders without COPD. The one-year excess direct medical cost of inpatient pneumonia in COPD patients was $ 22,697 ($45,456 in cases vs. $ 22,759 in controls (p <0.01)); 70.2% of this cost was accrued during the quarter of the index hospitalization. During months 13 through 24 following the index hospitalization, the excess direct medical cost was $ 5,941 ($23,215 in cases vs. $ 17,274 in controls, p<0.01). Conclusions Pneumonia occurs more frequently in elders with COPD than without COPD. The excess direct medical cost in elders with inpatient pneumonia extends up to 24 months following the index hospitalization and represents $28,638 in 2010 dollars.
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Affiliation(s)
- Marian Ryan
- Brandeis University, Schneider Institute on Healthcare Systems, Heller School, Waltham, Massachusetts, United States of America
- * E-mail:
| | - Jose A. Suaya
- GlaxoSmithKline Vaccines, Philadelphia, Pennsylvania, United States of America
| | - John D. Chapman
- Brandeis University, Schneider Institute on Healthcare Systems, Heller School, Waltham, Massachusetts, United States of America
| | - William B. Stason
- Brandeis University, Schneider Institute on Healthcare Systems, Heller School, Waltham, Massachusetts, United States of America
| | - Donald S. Shepard
- Brandeis University, Schneider Institute on Healthcare Systems, Heller School, Waltham, Massachusetts, United States of America
| | - Cindy Parks Thomas
- Brandeis University, Schneider Institute on Healthcare Systems, Heller School, Waltham, Massachusetts, United States of America
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Yañez AM, Guerrero D, Pérez de Alejo R, Garcia-Rio F, Alvarez-Sala JL, Calle-Rubio M, de Molina RM, Valle Falcones M, Ussetti P, Sauleda J, García EZ, Rodríguez-González-Moro JM, Franco Gay M, Torrent M, Agustí A. Monitoring breathing rate at home allows early identification of COPD exacerbations. Chest 2013; 142:1524-1529. [PMID: 22797131 DOI: 10.1378/chest.11-2728] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Respiratory frequency increases during exacerbations of COPD (ECOPD). We hypothesized that this increase can be detected at home before ECOPD hospitalization. METHODS To test this hypothesis, respiratory frequency was monitored at home daily for 3 months in 89 patients with COPD (FEV₁, 42.3% ± 14.0%; reference) who were receiving domiciliary oxygen therapy (9.6 ± 4.0 h/d). RESULTS During follow-up, 30 patients (33.7%) required hospitalization because of ECOPD. In 21 of them (70%), mean respiratory frequency increased (vs baseline) during the 5 days that preceded it (from 15.2 ± 4.3/min to 19.1 ± 5.9/min, P < .05). This was not the case in patients without ECOPD (16.1 ± 4.8/min vs 15.9 ± 4.9/min). Receiver operating characteristic analysis showed that 24 h before hospitalization, a mean increase of 4.4/min (30% from baseline) provided the best combination of sensitivity (66%) and specificity (93%) (area under the curve [AUC] = 0.79, P < .05). Two days before hospitalization, a mean increase of 2.3/min (15% change from baseline) was associated with a sensitivity of 72% and a specificity of 77% (AUC = 0.76, P < .05). CONCLUSIONS Respiratory frequency can be monitored daily at home in patients with COPD receiving domiciliary oxygen therapy. In these patients, breathing rate increases significantly days before they require hospitalization because of ECOPD. This may offer a window of opportunity for early intervention.
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Affiliation(s)
- Aina M Yañez
- Fundación de Investigación Sanitaria Illes Balears (FISIB), Palma de Mallorca, Madrid.
| | - Dolores Guerrero
- Fundación de Investigación Sanitaria Illes Balears (FISIB), Palma de Mallorca, Madrid
| | | | - Francisco Garcia-Rio
- Servicio de Neumología, Hospital Universitario La Paz, Instituto de Investigación La Paz (IdiPAZ), Madrid
| | - Jose Luis Alvarez-Sala
- Servicio de Neumología, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid
| | - Miriam Calle-Rubio
- Servicio de Neumología, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid
| | | | | | - Piedad Ussetti
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
| | - Jaume Sauleda
- Servei Pneumologia, Hospital Universitari Son Espases, Palma Mallorca
| | | | | | | | | | - Alvar Agustí
- Thorax Institute, Hospital Clínic, Institut d'Investigacions Biomediques Agustí Pi i Sunyer (IDIBAPS), Universitat Barcelona, CIBER Enfermedades Respiratorias (CIBERES), and Fundación de Investigación Sanitaria Illes Balears (FISIB) Mallorca, Spain
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Jaw JE, Sin DD. Unifying thoracic biomarkers: surfactant protein-D and beyond. Expert Rev Respir Med 2012; 6:147-54. [PMID: 22455487 DOI: 10.1586/ers.12.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disorder that affects 300 million people worldwide and is responsible for 3 million deaths annually. Currently, there are no accepted biomarkers of COPD, which has impaired drug development and management of patients with COPD. Pneumoproteins, which are proteins synthesized predominantly in the lungs, are promising blood biomarkers because they have high specificity for lung disease. The most promising is surfactant protein-D, which is synthesized largely in Type 2 pneumocytes, and its blood concentrations have been associated with COPD and with certain clinical end points such as mortality. In this paper, we discuss surfactant protein-D and other pneumoproteins as promising biomarkers of COPD.
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Affiliation(s)
- Jen Erh Jaw
- UBC James Hogg Research Center, The Institute for Heart and Lung Health, St Paul's Hospital and Department of Medicine (Pulmonary Division), University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Shafiek HA, Abd-Elwahab NH, Baddour MM, El-Hoffy MM, Degady AAE, Khalil YM. Assessment of some inflammatory biomarkers as predictors of outcome of acute respiratory failure on top of chronic obstructive pulmonary disease and evaluation of the role of bacteria. ISRN MICROBIOLOGY 2012; 2012:240841. [PMID: 23724320 PMCID: PMC3658585 DOI: 10.5402/2012/240841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/18/2012] [Indexed: 11/23/2022]
Abstract
Objective. To study the value of the inflammatory markers (interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP)) in predicting the outcome of noninvasive ventilation (NIV) in the management of acute respiratory failure (ARF) on top of chronic obstructive pulmonary disease (COPD) and the role of bacteria in the systemic inflammation. Methods. Thirty three patients were subjected to standard treatment plus NIV, and accordingly, they were classified into responders and nonresponders. Serum samples were collected for IL-6, IL-8, and CRP analysis. Sputum samples were taken for microbiological evaluation. Results. A wide spectrum of bacteria was revealed; Gram-negative and atypical bacteria were the most common (31% and 28% resp.; single or copathogen). IL-8 and dyspnea grade was significantly higher in the non-responder group (P = 0.01 and 0.023 resp.). IL-6 correlated positivity with the presence of infection and type of pathogen (P = 0.038 and 0.034 resp.). Gram-negative bacteria were associated with higher significant IL-6 in comparison between others (196.4 ± 239.1 pg/dL; P = 0.011) but insignificantly affected NIV outcome (P > 0.05). Conclusions. High systemic inflammation could predict failure of NIV. G-ve bacteria correlated with high IL-6 but did not affect the response to NIV.
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EDWARDS LLIFON, PERRIN KYLE, WIJESINGHE MEME, WEATHERALL MARK, BEASLEY RICHARD, TRAVERS JUSTIN. The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission. Respirology 2011; 16:625-9. [DOI: 10.1111/j.1440-1843.2011.01926.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fischer M, Scharloo M, Abbink J, 't Hul A, Ranst D, Rudolphus A, Weinman J, Rabe K, Kaptein AA. The dynamics of illness perceptions: Testing assumptions of Leventhal's common-sense model in a pulmonary rehabilitation setting. Br J Health Psychol 2010; 15:887-903. [DOI: 10.1348/135910710x492693] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hutchinson AF, Thompson MA, Brand CA, Black J, Anderson GP, Irving LB. Community care assessment of exacerbations of chronic obstructive pulmonary disease. J Adv Nurs 2010; 66:2490-9. [DOI: 10.1111/j.1365-2648.2010.05436.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Effects of inhaled corticosteroids in stable chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2010; 24:15-22. [PMID: 20816832 DOI: 10.1016/j.pupt.2010.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/30/2010] [Accepted: 08/20/2010] [Indexed: 11/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has been described as a heterogeneous multifactorial disorder associated with an abnormal inflammatory response of the peripheral airways and with variable morphologic, physiologic and clinical phenotypes. This notion of the disease is actually poorly supported by data, and there are substantial discrepancies and a weak correlation between inflammation, structural damage, functional impairment and degree of clinical symptoms. This problem is compounded by a poor understanding of the complexity and intricacies on the inflammatory pathways in COPD. Despite the evidence for efficacy of inhaled corticosteroids (ICS) on selected clinical endpoints in COPD, we cannot assume that anti-inflammatory treatment with ICS alone or in combination with long-acting bronchodilators will necessarily improve the underlying inflammatory processes and patient relevant outcomes in COPD. Given the widespread use of inhaled corticosteroids (ICS) alone or in combination for the treatment of COPD across all severities, it is important to weigh their clinically proven benefits and shortcomings cautiously and critically. Reviewed is the current evidence-based role of ICS on inflammatory markers and patient relevant outcomes in COPD.
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Nicholas BL, Skipp P, Barton S, Singh D, Bagmane D, Mould R, Angco G, Ward J, Guha-Niyogi B, Wilson S, Howarth P, Davies DE, Rennard S, O'Connor CD, Djukanovic R. Identification of lipocalin and apolipoprotein A1 as biomarkers of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 181:1049-60. [PMID: 20110559 DOI: 10.1164/rccm.200906-0857oc] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Much effort is being made to discover noninvasive biomarkers of chronic airway disease that might enable better management, predict prognosis, and provide new therapeutic targets. OBJECTIVES To undertake a comprehensive, unbiased proteomic analysis of induced sputum and identify novel noninvasive biomarkers for chronic obstructive pulmonary disease (COPD). METHODS Induced sputum was obtained from patients with COPD with a spectrum of disease severity and from control subjects. Two-dimensional gel electrophoresis and mass spectrometric identification of differentially expressed proteins were first applied to induced sputum from patients with GOLD stage 2 COPD and healthy smoker control subjects. Initial results thus obtained were validated by a combination of immunoassays (Western blotting and ELISA) applied to a large subject cohort. The biomarkers were localized to bronchial mucosa by immunohistochemistry. MEASUREMENTS AND MAIN RESULTS Of 1,325 individual protein spots identified, 37 were quantitatively and 3 qualitatively different between the two groups (P < 0.05%). Forty protein spots were subjected to tandem mass spectrometry, which identified 15 separate protein species. Seven of these were further quantified in induced sputum from 97 individuals. Using this sequential approach, two of these potential biomarkers (apolipoprotein A1 and lipocalin-1) were found to be significantly reduced in patients with COPD when compared with healthy smokers. Their levels correlated with FEV(1)/FVC, indicating their relationship to disease severity. CONCLUSIONS A potential role for apolipoprotein A1 and lipocalin-1 in innate defense has been postulated previously; our discovery of their reduction in COPD indicates a deficient innate defense system in airway disease that could explain increased susceptibility to infectious exacerbations.
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Affiliation(s)
- Benjamin L Nicholas
- Inflammatory Cell Biology Group, Division of Infection, Inflammation, and Immunity, Sir Henry Wellcome Laboratories, South Block, Southampton General Hospital, Southampton, UK.
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Tsimogianni AM, Papiris SA, Kanavaki S, Stathopoulos GT, Sotiropoulou C, Manali ED, Michalopoulou P, Roussos C, Kotanidou A. Predictors of positive sputum cultures in exacerbations of chronic obstructive pulmonary disease. Respirology 2009; 14:1114-20. [PMID: 19761538 DOI: 10.1111/j.1440-1843.2009.01615.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Although sputum culture in patients with an acute exacerbation of COPD is of uncertain value, it is routinely done. The ability to clinically identify patients likely or unlikely to yield bacterial sputum isolates would potentially reduce unnecessary tests. The objective of this study was to identify the clinical predictors of positive sputum cultures in this patient population. METHODS Consecutive patients with a COPD exacerbation requiring an emergency visit were prospectively enrolled. Quantitative sputum culture was performed on-site. Data on current smoking, sputum purulence, FEV(1), Medical Research Council chronic dyspnoea scale, BMI, severe exacerbations in the preceding year requiring hospitalization, PaO(2), PaCO(2), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and oral and inhaled steroid use were recorded. RESULTS Of the 94 patients enrolled, sputum from 36 yielded bacterial pathogens. These patients were characterized by a higher frequency of purulent sputum, lower FEV(1), BMI and PaO(2,) higher APACHE II score and more frequent use of inhaled steroids (P < 0.05). On multivariate regression, purulent sputum, FEV(1) and BMI were independent determinants of a positive sputum culture. Using receiver-operator-optimized thresholds for these variables (purulent sputum, FEV(1) < 35% predicted and BMI < or = 22 kg/m(2)), we proposed a regression coefficient-weighted prediction model that accurately determined the likelihood of sputum bacterial isolation. CONCLUSIONS A prediction model based on the variables of purulent sputum, FEV(1) and BMI predicted sputum culture result with about 90% accuracy. Pending further validation, this model may save valuable healthcare resources.
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Affiliation(s)
- Angeliki M Tsimogianni
- Department of Critical Care and Pulmonary Services, General Hospital Evangelismos, School of Medicine, National and Kapodistrian University of Athens, 10675 Athens, Greece.
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Corradi M, Acampa O, Goldoni M, Andreoli R, Milton D, Sama SR, Rosiello R, de Palma G, Apostoli P, Mutti A. Metallic elements in exhaled breath condensate and serum of patients with exacerbation of chronic obstructive pulmonary disease. Metallomics 2009; 1:339-45. [PMID: 21305131 DOI: 10.1039/b907635b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Biomarkers in exacerbated chronic obstructive pulmonary disease may be useful in aiding diagnosis, defining specific phenotypes of disease, monitoring the disease and evaluating the effects of drugs. The aim of this study was the characterization of metallic elements in exhaled breath condensate and serum as novel biomarkers of exposure and susceptibility in exacerbated chronic obstructive pulmonary disease using reference analytical techniques. C-Reactive protein and procalcitonin were assessed as previously validated diagnostic and prognostic biomarkers which have been associated with disease exacerbation, thus useful as a basis of comparison with metal levels. Exhaled breath condensate and serum were obtained in 28 patients at the beginning of an episode of disease exacerbation and when they recovered. Trace elements and toxic metals were measured by inductively coupled plasma-mass spectrometry. Serum biomarkers were measured by immunoassay. Exhaled manganese and magnesium levels were influenced by exacerbation of chronic obstructive pulmonary disease, an increase in their concentrations--respectively by 20 and 50%--being observed at exacerbation in comparison with values obtained at recovery; serum elemental composition was not modified by exacerbation; serum levels of C-reactive protein and procalcitonin at exacerbation were higher than values at recovery. In outpatients who experienced a mild-moderate chronic obstructive pulmonary disease exacerbation, manganese and magnesium levels in exhaled breath condensate are elevated at admission in comparison with values at recovery, whereas no other changes were observed in metallic elements at both the pulmonary and systemic level.
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Affiliation(s)
- Massimo Corradi
- Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Italy
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Koutsokera A, Kiropoulos TS, Nikoulis DJ, Daniil ZD, Tsolaki V, Tanou K, Papaioannou AI, Germenis A, Gourgoulianis KI, Kostikas K. Clinical, functional and biochemical changes during recovery from COPD exacerbations. Respir Med 2009; 103:919-26. [DOI: 10.1016/j.rmed.2008.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 11/02/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
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Abstract
A standardized definition of chronic obstructive pulmonary disease (COPD) exacerbation still represents an unmet need in respiratory medicine; definitions currently rely on clinical empiricism with little evidence-based scientific support. Exacerbations of COPD are certainly clear events in the mind of practicing physicians. However, when one tries to provide simple concepts such as their definition and classification of severity, one realizes how little we know. Current symptom- and event-based definitions of a COPD exacerbation, as well as the classifications of the severity of COPD exacerbations, all have their own limitations. Efforts to assess the efficacy of new therapies in the treatment and prevention of COPD exacerbations have been hampered by the lack of a widely agreed upon and consistently used definition. There is a need for greater investment in research on COPD exacerbations in order to promote a better understanding of COPD exacerbations.
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Abstract
Concepts relating to the natural history of chronic obstructive pulmonary disease (COPD) arise most importantly from the classic study of Fletcher and colleagues (The Natural History of Chronic Bronchitis and Emphysema, Oxford University Press, New York, 1976). This study, which evaluated working English men over 8 years, was used to construct a proposed life-long natural history. Although this is a classic study that has greatly advanced understanding of COPD, it has a number of limitations. Its duration is relatively short compared with the duration of COPD, so it is more cross-sectional than longitudinal. It was unable to distinguish among varied "natural histories." It assessed primarily the FEV(1), and the natural history of other features of COPD is largely undescribed. With advances in understanding the clinical features of COPD and with the development of evaluating new tools to assess patients with COPD, longitudinal studies evaluating COPD in novel ways and for longer durations are needed.
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Abstract
COPD is one of the most common causes of morbidity and mortality. Perhaps paradoxically, COPD also should be an orphan disease. Importantly, this could advance the development of treatments for COPD. There are two criteria for orphan status in the United States. Most widely known is the criterion of < 200,000 affected individuals; however, secondarily, is the impossibility for development costs to be recovered during the patent life of a product. COPD should qualify for the first criterion if the various conditions that comprise COPD are regarded separately. The subphenotyping of COPD into separate groups based on mechanism sets the stage for the rational development of therapeutics. In addition, many candidate treatments may alter the natural history of COPD. Testing them, however, will require large studies for a duration that will compromise the commercial life of any resulting product. Orphan status, therefore, could facilitate the development of treatments for both phenotypic subsets of COPD patients as well as aid the development of agents to alter the natural history of the disease. Post-drug approval regulations could require that agents approved under the orphan provisions are prospectively monitored, assuring that rigorous longitudinal data are generated. This approach could encourage the pharmaceutical industry to stratify studies based on a more detailed characterization of study subjects at baseline, thus approaching "many small COPDs" instead of a single large and heterogeneous COPD. This strategy may help to address the increasing burden that COPD presents and for which no novel clinical class of treatment has been introduced for 30 years.
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Inhalation of the nerve gas sarin impairs ventilatory responses to hypercapnia and hypoxia in rats. Toxicol Appl Pharmacol 2008; 232:440-7. [PMID: 18706921 DOI: 10.1016/j.taap.2008.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/16/2008] [Accepted: 07/17/2008] [Indexed: 02/07/2023]
Abstract
Sarin, a highly toxic nerve gas, is believed to cause bronchoconstriction and even death primarily through respiratory failure; however, the mechanism underlying the respiratory failure is not fully understood. The goals of this study were to ascertain whether sarin affects baseline ventilation (VE) and VE chemoreflexes as well as airway resistance and, if so, whether these changes are reversible. Four groups of F344 rats were exposed to vehicle (VEH) or sarin at 2.5, 3.5, and 4.0 mg h m(-3) (SL, SM, and SH, respectively). VE and VE responses to hypercapnia (7% CO2) or hypoxia (10% O2) were measured by plethysmography at 2 h and 1, 2, and 5 days after VEH or sarin exposure. Total pulmonary resistance (RL) also was measured in anesthetized VEH- and SH-exposed animals 2 h after exposure. Our results showed that within 2 h after exposure 11% of the SM- and 52% of the SH- exposed groups died. Although the SM and SH significantly decreased hypercapnic and hypoxic VE to similar levels (64 and 69%), SH induced greater respiratory impairment, characterized by lower baseline VE (30%; P<0.05), and total loss of the respiratory frequency response to hypercapnia and hypoxia. VE impairment recovered within 1-2 days after sarin exposure; interestingly, SH did not significantly affect baseline RL. Moreover, sarin induced body tremors that were unrelated to the changes in the VE responses. Thus, LC50 sarin causes a reversible impairment of VE that is not dependent on the sarin-induced body tremors and not associated with changes in RL.
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Sin DD, Man SFP, Marciniuk DD, Ford G, FitzGerald M, Wong E, York E, Mainra RR, Ramesh W, Melenka LS, Wilde E, Cowie RL, Williams D, Gan WQ, Rousseau R. The effects of fluticasone with or without salmeterol on systemic biomarkers of inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 177:1207-14. [PMID: 18310480 DOI: 10.1164/rccm.200709-1356oc] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE Small studies have suggested that inhaled corticosteroids can suppress systemic inflammation in chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine the effect of inhaled corticosteroids with or without long-acting beta(2)-adrenergic agonist on systemic biomarkers of inflammation. METHODS We conducted a double-blind randomized placebo-controlled trial across 11 centers (n = 289 patients with FEV(1) of 47.8 +/- 16.2% of predicted) to compare the effects of inhaled fluticasone alone or in combination with salmeterol against placebo on circulating biomarkers of systemic inflammation over 4 weeks. The primary endpoint was C-reactive protein (CRP) level. Secondary molecules of interest were IL-6 and surfactant protein D (SP-D). MEASUREMENTS AND MAIN RESULTS Neither fluticasone nor the combination of fluticasone/salmeterol had a significant effect on CRP or IL-6 levels. There was, however, a significant reduction in SP-D levels with fluticasone and fluticasone/salmeterol compared with placebo (P = 0.002). Health status also improved significantly in both the fluticasone and fluticasone/salmeterol groups compared with placebo, driven mostly by improvements in the symptom scores. Changes in the circulating SP-D levels were related to changes in health status scores. FEV(1) improved significantly only in the fluticasone/salmeterol group compared with placebo. CONCLUSIONS ICS in conjunction with long-acting beta(2)-adrenergic agonist do not reduce CRP or IL-6 levels in serum of patients with COPD over 4 weeks. They do, however, significantly reduce serum SP-D levels. These data suggest that these drugs reduce lung-specific but not generalized biomarkers of systemic inflammation in COPD.
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Affiliation(s)
- Don D Sin
- Department of Medicine, Respiratory Division, University of British Columbia, Vancouver, Canada
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Yao H, de Boer WI, Rahman I. Targeting lung inflammation: novel therapies for the treatment of COPD. CURRENT RESPIRATORY MEDICINE REVIEWS 2008; 4:57-68. [PMID: 19672474 PMCID: PMC2723817 DOI: 10.2174/157339808783497873] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health problem. As understanding of pathology of COPD has increased it has been established that COPD is associated with the progressive pulmonary inflammation and destruction of lung parenchyma (emphysema) that relate to disease severity. Therefore, it is anticipated that drugs that reduce pulmonary inflammation will provide effective, disease modifying therapy for COPD. Several specific therapies are directed against the influx of inflammatory cells into the airways and lung parenchyma that occurs in COPD; these include agents directed against cytokines and chemokines. Broad-range anti-inflammatory drugs are now in phase III development for COPD; they include inhibitors of phosphodiesterase 4 (PDE4). Other drugs that inhibit cell signaling include inhibitors of p38 mitogen-activated protein kinase (MAPK), nuclear factor-κB (NF-κB), and phosphoinositide-3-kinase (PI3K). There is also a search for inhibitors of proteinases and matrix metalloproteinases (MMPs) to prevent lung destruction and the development of emphysema. This review highlights studies on novel or potential anti-inflammatory agents that might be considered in the development of new future therapies for COPD.
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Affiliation(s)
- Hongwei Yao
- Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Irfan Rahman
- Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester, NY, USA
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Bozinovski S, Hutchinson A, Thompson M, Macgregor L, Black J, Giannakis E, Karlsson AS, Silvestrini R, Smallwood D, Vlahos R, Irving LB, Anderson GP. Serum amyloid a is a biomarker of acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 177:269-78. [PMID: 18006888 DOI: 10.1164/rccm.200705-678oc] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Much of the total disease burden and cost of chronic obstructive pulmonary disease (COPD) is associated with acute exacerbations of COPD (AECOPD). Serum amyloid A (SAA) is a novel candidate exacerbation biomarker identified by proteomic screening. OBJECTIVES To assess SAA as a biomarker of AECOPD. METHODS Biomarkers were assessed (1) cross-sectionally (stable vs. AECOPD; 62 individuals) and (2) longitudinally with repeated measures (baseline vs. AECOPD vs. convalescence; 78 episodes in 37 individuals). Event severity was graded (I, ambulatory; II, hospitalized; III, respiratory failure) based on consensus guidelines. MEASUREMENTS AND MAIN RESULTS Presumptively newly acquired pathogens were associated with onset of symptomatic AECOPD. In the cross-sectional study, both SAA and C-reactive protein (CRP) were elevated at AECOPD onset compared with stable disease (SAA median, 7.7 vs. 57.6 mg/L; P < 0.01; CRP median, 4.6 vs. 12.5 mg/L; P < 0.01). Receiver operator characteristics analysis was used to generate area-under-curve values for event severity. SAA discriminated level II/III events (SAA, 0.88; 95% confidence interval, 0.80-0.94 vs. CRP, 0.80; 95% confidence interval, 0.70-0.87; P = 0.05). Combining SAA or CRP with major symptoms (Anthonisen criteria, dyspnea) did not further improve the prediction model for severe episodes. IL-6 and procalcitonin were not informative. CONCLUSIONS SAA is a novel blood biomarker of AECOPD that is more sensitive than CRP alone or in combination with dyspnea. SAA may offer new insights into the pathogenesis of AECOPD.
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Affiliation(s)
- Steven Bozinovski
- Department of Pharmacology, Medical Building (Level 8), University of Melbourne, Parkville, 3010 Australia.
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Sin DD, Leung R, Gan WQ, Man SP. Circulating surfactant protein D as a potential lung-specific biomarker of health outcomes in COPD: a pilot study. BMC Pulm Med 2007; 7:13. [PMID: 17922919 PMCID: PMC2096624 DOI: 10.1186/1471-2466-7-13] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 10/08/2007] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is a paucity of surrogate lung-specific biological markers that can be used to track disease progression and predict clinical outcomes in chronic obstructive pulmonary disease (COPD). The principal aim of this pilot study was to determine whether circulating surfactant protein D (SPD) or Clara Cell protein-16 (CC16) levels are associated with lung function or health status in patients with severe COPD. METHODS We studied 23 patients with advanced COPD. Lung function measurements, Chronic Respiratory Disease Questionnaire (CRQ) scores, and serum levels of SPD, CC16, and C-reactive protein (CRP) were determined at baseline and at 3 months. RESULTS At baseline, FEV(1) was inversely associated with serum SPD levels (P = 0.045) but not with CC16 (P = 0.675) or CRP levels (P = 0.549). Over a 3 month period, changes in SPD levels correlated significantly with changes in CRQ scores (adjusted P = 0.008) such that patients who had the largest declines in serum SPD levels experienced the largest gains in health status. The association was particularly notable between circulating SPD level and the dyspnea domain of the CRQ score (P = 0.018). Changes in CC16 or CRP levels did not correlate with changes in CRQ scores. CONCLUSION Changes in serum SPD levels tracked well with changes in health status over a 3 month period in patients with severe COPD. These data suggest that circulating SPD levels may be useful biomarkers to track health outcomes of COPD patients.
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Affiliation(s)
- Don D Sin
- The University of British Columbia (Respiratory Division), Vancouver, BC.
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Rabe KF, Beghé B, Luppi F, Fabbri LM. Update in chronic obstructive pulmonary disease 2006. Am J Respir Crit Care Med 2007; 175:1222-32. [PMID: 17545457 DOI: 10.1164/rccm.200704-586up] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Klaus F Rabe
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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Xu F, Zhuang J, Wang R, Seagrave JC, March TH. Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema. Respir Physiol Neurobiol 2007; 158:5-13. [PMID: 17531548 PMCID: PMC2703296 DOI: 10.1016/j.resp.2007.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 04/05/2007] [Accepted: 04/05/2007] [Indexed: 11/25/2022]
Abstract
It has been reported that the degree of emphysema induced by chronic cigarette smoke (CS) is greater in female C3H/HeN mice as compared to other mouse strains. We hypothesized that these mice would develop the similar major characteristics seen in hypercapnic patients with chronic obstructive pulmonary disease (COPD), including emphysema, pulmonary inflammation, hypercapnia/hypoxemia, rapid breathing, and attenuated ventilatory response (AVR). Mice were exposed either to CS or filtered air (FA) for 16 weeks. After exposure, arterial blood gases and minute ventilation were measured before and during chemical challenges in anesthetized and spontaneously breathing mice. We found that as compared to FA, CS exposure caused emphysema and pulmonary inflammation associated with: (1) hypercapnia and hypoxemia, (2) rapid breathing, and (3) AVR to 25 breaths of pure N(2), 5% CO(2) alone, and 5% CO(2) coupled with 10% O(2). The similarity of these pathophysiological characteristics between our mouse model and COPD patients suggests that this model could be effectively applied to study COPD pathophysiology, especially central mechanisms of the AVR genesis.
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Affiliation(s)
- F Xu
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM 87108, USA.
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Stolz D, Christ-Crain M, Morgenthaler NG, Leuppi J, Miedinger D, Bingisser R, Müller C, Struck J, Müller B, Tamm M. Copeptin, C-Reactive Protein, and Procalcitonin as Prognostic Biomarkers in Acute Exacerbation of COPD. Chest 2007; 131:1058-67. [PMID: 17426210 DOI: 10.1378/chest.06-2336] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A novel approach to estimate the severity of COPD exacerbation and predict its outcome is the use of biomarkers. We assessed circulating levels of copeptin, the precursor of vasopressin, C-reactive protein (CRP), and procalcitonin as potential prognostic parameters for in-hospital and long-term outcomes in patients with acute exacerbation of COPD (AECOPD) requiring hospitalization. METHODS Data of 167 patients (mean age, 70 years; mean FEV(1), 39.9 +/- 16.9 of predicted [+/- SD]) presenting to the emergency department due to AECOPD were analyzed. Patients were evaluated based on clinical, laboratory, and lung function parameters on hospital admission, at 14 days, and at 6 months. RESULTS Plasma levels of all three biomarkers were elevated during the acute exacerbation (p < 0.001), but levels at 14 days and 6 months were similar (p = not significant). CRP was significantly higher in patients presenting with Anthonisen type I exacerbation (p = 0.003). In contrast to CRP and procalcitonin, copeptin on hospital admission was associated with a prolonged hospital stay (p = 0.002) and long-term clinical failure (p < 0.0001). Only copeptin was predictive for long-term clinical failure independent of age, comorbidity, hypoxemia, and lung functional impairment in multivariate analysis (p = 0.005). The combination of copeptin and previous hospitalization for COPD increased the risk of poor outcome (p < 0.0001). Long-term clinical failure was observed in 11% of cases with copeptin < 40 pmol/L and no history of hospitalization, as compared to 73% of patients with copeptin >/= 40 pmol/L and a history of hospitalization (p < 0.0001). CONCLUSIONS We suggest copeptin as a prognostic marker for short-term and long-term prognoses in patients with AECOPD requiring hospitalization.
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Affiliation(s)
- Daiana Stolz
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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Benhamou D, Goupil F. Les infections respiratoires basses communautaires de l’adulte non immunodéprimé. Rev Mal Respir 2007; 24:381-6. [PMID: 17417181 DOI: 10.1016/s0761-8425(07)91075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Benhamou
- Service de Pneumologie, CHU Rouen, France.
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